The purpose of this research is to measure the effect of an educational intervention for certified nursing assistants (CNAs) on the oral care of frail and functionally dependent nursing home (NH) elders. The specific aims of the study are: 1) Collect and analyze data surrounding the knowledge, opinions, and practices of CNAs providing oral hygiene care to frail and functionally dependent elders; 2) Develop an oral care educational program to address deficits in the knowledge, opinions, and practices of CNAs who provide oral care for cognitively impaired NH residents; and 3) Pilot test the educational program in two facilities that differ in ownership, geographic location, and resident demographics. All of the CNAs in 2 NHs will be surveyed in order to meet specific aim #1. A sample of 39 NH residents residing on the Alzheimer's Units of both NHs will be recruited for the study. Denture and dental plaque, functional status, resistance to care, and cognitive impairment will be measured and recorded. The quantity and quality of the oral care provided by a sample of 48 CNAs from both Alzheimer's Units will be measured. The CNAs will receive a 1-hour training session on providing oral care to cognitively impaired and care resistant elders followed by an hour of oneon- one structured support during their usual working hours, where the investigator or research assistant will help the CNAs apply the strategies they learned to real-life patient care situations. The effectiveness of the intervention will be measured by the amount of plaque on the teeth and dentures at 4 weeks, 8 weeks, and 12 weeks post-intervention. Repeated measures ANOVA will be examined to determine the impact of the educational intervention on the plaque scores of the NH elders. Terms in the model will include the nursing facility and time. A decrease in plaque scores from the baseline measurement to week 4 will be interpreted as an immediate measure of efficacy regarding the educational intervention. A sustained effect will be measured by the plaque scores measured at weeks 8 and 12. [unreadable] [unreadable] [unreadable]